title: Semi-urgent surgery in hospitalized patients with severe ulcerative colitis does not increase overall J-pouch complications.
abstract: BACKGROUND
  Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes.
  
  
  METHODS
  Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review.
  
  
  RESULTS
  Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤ .05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P < .0001) and fewer laparoscopic procedures (8.8% vs 18%, P = .07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤ .05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P = .05] and pouch failure (odds ratio, 13.3; P = .01).
  
  
  CONCLUSIONS
  Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.
authors.affiliation: Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA; The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, USA.
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.affiliation: Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hodin
authors.affiliation: Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA. Electronic address: lbordeianou@partners.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007297:Inpatients; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Complications of IBD; Surgery for IBD; Ulcerative colitis